In the early-implementation (pre-December 2010) states, Medicaid and CHIP staff cited a number of potential benefits to applicants from their ELE programs (Table II.4). In five of the seven ELE programs (all but Alabama and Maryland), ELE required that applicants submit fewer documents in support of their ELE applications compared to standard applications, and required fewer interactions with state staff.17 In addition, in six programs (all but Maryland), ELE applications were processed more quickly than standard applications, which resulted in expedited eligibility determinations for families. Indeed, these expedited processes shortened the typical time from application to enrollment for an eligible child from roughly three or four weeks to one week or less.
Some states also noted that ELE has improved the application experience of non-ELE applicants. For example, in New Jersey, the use of tax information in ELE has led to more extensive use of tax information in standard application processing. Specifically, people applying via the standard route are permitted to attest to income and are not required to provide pay stubs if their attestation matches tax return data.18 Simplifications made to the application materials in support of ELE in New Jersey, such as a streamlined presentation of managed care plan options, were also carried over to standard applications. In Alabama and Louisiana, state staff suggested that the time saved by diverting some applications to ELE routes has meant that standard processing times for non-ELE applications are shorter than they would be otherwise.
Table II.4. Perceived Benefits of ELE for Applicants
|State Program Using ELE||Alabama Medicaid||Iowa Medicaid||Iowa Separate CHIP||Louisiana Medicaid||Maryland Medicaid||New Jersey Medicaid/CHIP||Oregon Medicaid/CHIP|
|Supporting Documentation Requested of Applicants Through ELE Method||Identity Citizenship Social Security Medical coverage (if applicable)||None||Medical coverage (if applicable)||None||Income Citizenship/ immigration status Social Security Expenses||None||Medical coverage (if applicable)|
|Supporting Documentation Requested of Applicants Through Standard Method||Identity Citizenship Social Security Medical coverage (if applicable)||Identity Income Citizenship Social Security||Identity Income Citizenship/ immigration status Social Security Medical coverage (if applicable)||Income Citizenship/ immigration status Bank accounts Medical coverage (if applicable)||Income Citizenship/ immigration status Social Security Expenses||Income Citizenship/ immigration status Medical coverage (if applicable)||Income Citizenship/ immigration status (in some cases) Social Security Employment status Medical coverage (if applicable)|
|Time from Application Receipt to Coverage (Days) Through ELE Method||<6||2||5a||<1||No difference||7||3|
|Time from Application Receipt to Coverage (Days) Through Standard Method||<25||<30||20||<30||No difference||30||9|
|Interactions with the State||No difference||Fewer||Fewer||Fewer||No difference||Fewer||Fewer|
Source: Mathematica analysis of interviews with state staff. Information about documentation requirements reflects interviews with state staff supplemented by a review of Medicaid and CHIP websites and application materials.
a ELE enrollees to the separate CHIP program are enrolled roughly five days after the referral from Medicaid; however, coverage is retroactive to the Medicaid filing date.
CHIP = Children’s Health Insurance Program; ELE = Express Lane Eligibility.
17 In Alabama, self-declaration of income has been accepted for most ELE and non-ELE children since April 2010. This is not the case for children of self-employed parents, for whom income verification is required. Thus, ELE reduces the documentation burden for children with self-employed parents whose income cannot be verified via other databases but can be verified via SNAP or TANF databases. However, for most families, documentation requirements under ELE remain the same as those under the traditional application process.
18 State staff do not recognize this use of tax return information in processing standard applications as ELE; we will use the case study in the evaluation’s second year to further understand this ELE-like process.